Endovascular treatment of an unruptured ophthalmic artery aneurysm with a flow diverter: a case report
An unruptured aneurysm is often asymptomatic or present without neurological deficits, causing severe morbidity. However, the potential of this defect to rupture requires proper management. Herein, we report a case of an unruptured saccular aneurysm of the ophthalmic artery with initial clinical seizures. The patient was treated by flow diversion which redirects the blood flow that normally leads to the protrusion of the aneurysm back to the main vessel. Flow diversion is chosen because it is less risky and has a faster recovery time than other treatment options, but it is more expensive than others. Although this technology is not new, there is no report on its implementation in Indonesia. The patient was prescribed antiplatelet treatment for at least 6 months post-treatment, then she showed no sign of seizure or new focal neurological deficits 4 months post-treatment. The patients were expected to undergo digital subtraction angiography evaluation 6 months after flow diversion treatment, but it has not been performed due to the coronavirus disease 2019 pandemic.
Feigin VL, Norriving B, Mensah GA. Global burden of stroke. Circ Res. 2017;120(3):439-48. https://doi.org/10.1161/CIRCRESAHA.116.308413
Ministry of Health of The Republic of Indonesia. Basic Health Research (RISKESDAS) 2018. Ministry of Health of the Republic of Indonesia: National Institute of Health Research and Development; 2018. Indonesian.
Date I. Symptomatic unruptured cerebral aneurysms: features and surgical outcome. Neurol Med Chir (Tokyo). 2010;50(9):788-99. https://doi.org/10.2176/nmc.50.788
Thompson BG, Brown RD Jr, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES Jr, et al. Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(8):2368-400. https://doi.org/10.1161/STR.0000000000000070
Moon K, Albuquerque FC, Ducruet AF, Crowley RW, McDougall CG. Treatment of ophthalmic segment carotid aneurysms using the pipeline embolization device: clinical and angiographic follow-up. Neurol Res. 2014;36(4):344-50. https://doi.org/10.1179/1743132814Y.0000000322
Zhao L, Wang R, Song B, Tan S, Gao Y, Fang H, et al. Association between atherogenic dyslipidemia and recurrent stroke risk in patients with different subtypes of ischemic stroke. Int J Stroke. 2015;10(5):752-8. https://doi.org/10.1111/ijs.12471
Sellar R. Complications of interventional treatment of cerebral aneurysms. Interv Neuroradiol. 2008;14(Suppl 1):63-74. https://doi.org/10.1177/15910199080140S112
Sena JC, Reynier Y, Alliez B. Unruptured intracranial aneurysm presenting with epiletic seizure. Arq Neuropsiquiatr. 2003;61(3-A):663-7. https://doi.org/10.1590/S0004-282X2003000400026
Kamali AW, Cockerell OC, Butlar P. Aneurysms and epilepsy: an increasingly recognised cause. Seizure. 2004;13(1):40-4. https://doi.org/10.1016/S1059-1311(03)00075-X
Zanaty M, Chalouhi N, Barros G, Schwartz EW, Saigh MP, Starke RM, et al. Flow-diversion for ophthalmic segment aneurysms. Neurosurgery. 2015;76(3):286-9; discussion 289-90. https://doi.org/10.1227/NEU.0000000000000607
Rangel-Castilla L, Nakaji P, Siddiqui AH, Spetzler RF, Levy EI, editors. Decision making in neurovascular disease [Internet]. Stuttgart: Thieme Verlagsgruppe; 2018 [cited Jul 17 2020].Available from: http://www.thieme-connect.de/products/ebooks/book/10.1055/b-006-160136. https://doi.org/10.1055/b-0038-162129
Alderazi YJ, Shastri D, Kass-Hout T, Prestigiacomo CJ, Gandhi CD. Flow diverters for intracranial aneurysms. Stroke Res Treat. 2014;2014: 415653. https://doi.org/10.1155/2014/415653
Dholakia R, Sadasivan C, Fiorella DJ, Woo HH, Lieber BB. Hemodynamics of flow diverters. J Biomech Eng. 2017;139(2). https://doi.org/10.1115/1.4034932
Burrows AM, Brinjikji W, Puffer RC, Cloft H, Kallmes DF, Lanzino G. Flow diversion for ophthalmic artery aneurysms. Am J Neuroradiol. 2016;37(10):1866-9. https://doi.org/10.3174/ajnr.A4835
Tonetti DA, Jankowitz BT, Gross BA. Antiplatelet therapy in flow diversion. Neurosurgery. 2020;86(Suppl 1):S47-52. https://doi.org/10.1093/neuros/nyz391
Copyright (c) 2021 Rakhmad Hidayat, Fadila Asmaniar, Affan Priambodo, Taufik Mesiano, Muhammad Kurniawan, Al Rasyid, Salim Harris
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.